Thyroid Medication: Do You Really Need It?

I get it. When you hear the words “thyroid medication” you might bristle. Who wants to take a medication they don’t really need? After all, we hear about problems with medication over-prescribing and the risks of pharmaceutical side-effects all the time. It can be scary to think about starting a medication. And it also may not fit into your ideal self-concept – most of us don’t want to think of ourselves as needing a medication, let alone for our whole lives!

So what do you do if you’re faced with a diagnosis of Hashimoto’s or hypothyroidism and have been prescribed thyroid medication? Or have been so exhausted for so long now, have felt depressed, unfocused, or are still gaining weight despite your best efforts at diet and exercise – and now you’re ready to do just about anything to feel like yourself again.

You’ve heard thyroid medication can help with energy, weight, and mood… But do you need it? is it safe? Will you become dependent on it? Is it better to wait and work on Root Causes first to try to avoid medication?

I get questions about thyroid medication pretty much every day and it’s great that you’re asking, too! The most common questions women ask me are:

• What is thyroid medication, exactly?
• How do I know if – and when – I really need to start one?
• Do I have to take medication if I have hypothyroidism? What are the risks if I don’t?
• Can I put if off taking it and instead keep trying to heal my root causes?
• Does medication really make a difference in my health?
• How will I know if it’s helping?
• Is it safe?
• Is taking it going to make me dependent on thyroid medication for the rest of my life?

In this article, I’m going to walk you through, step-by-step, my answers to each of these questions, which is how I help my patients with this big decision, and will hopefully help you, too.

What Is Thyroid Medication?

Thyroid medication, used for the treatment of hypothyroidism and Hashimoto’s, refers to pharmaceutical products containing thyroid hormones.

Thyroid hormone medications may include:

• The inactive form of thyroid hormone, T4, which your body is then meant to convert into the active form T3
• The active form of thyroid hormone, T3, which your body is meant to use directly
• A combination of both T3 and T4.

These are natural or synthetic versions (derived from natural sources, such as dessicated animal glands) of the hormones your body should naturally produce, but is currently not producing in a large enough quantity, is not producing them at all, or is unable to convert from the inactive to the active form that your body can then use. These products may be time released, individually compounded, or have other nuances to them. In my book, The Adrenal Thyroid Revolution, I walk you through the various thyroid medication choices that are available and commonly recommended.

Thyroid Medication Reframe

I prefer to use the term thyroid hormone supplementation over thyroid medication. While I don’t want to minimize the fact that these are pharmaceuticals, a lot of us recoil at the term medication, and even more so at the idea that we might end up on one chronically. Reframing what you call them can help you to feel more comfortable making the decision to use them should you need to. It’s also an important distinction, because thyroid hormone isn’t a foreign chemical designed in a lab to cause unnatural changes in your body. It's a synthetic or natural version of the very same hormone your body is supposed to be producing to keep your metabolism, energy, mood, mental focus, and hormones humming at their best speed and effectiveness for your well-being.

Think of it this way: If you weren’t making enough Vitamin D (technically also a hormone, not a vitamin), you’d do your best to improve your diet and maybe get more sun exposure, but you’d probably also readily take a supplement if you needed it, for optimal health. So too that’s how I think of thyroid hormone. It’s a supplement for when your body just isn’t making enough, which might be for a time, or for the duration. It’s not a small decision, and it’s not something we should simply take as easily as walking into the store and getting Vitamin D, but my hope is to put it into a context that makes it easier to accept should you truly need it.

Thyroid Medication: Do I Really Need It?

When determining whether you need thyroid hormone supplementation, the first thing to do is get a panel of hypothyroid testing labs including TSH, Free T3, Free T4 and TPO, and have these properly interpreted by a licensed health practitioner qualified to interpret labs. Here is a list of thyroid labs and and how I interpret them with my patients.

If Hashimoto’s or hypothyroidism are not demonstrable on your laboratory testing, then it is not appropriate to use thyroid hormone supplementation. Instead, it’s important to find out what’s causing these symptoms, as there are other conditions that can cause many of the same symptoms as hypothyroidism. If a practitioner suggests you start thyroid hormone supplementation without properly testing you, or in the absence of abnormal lab findings, find another practitioner, ASAP.

If labs do show that you have Hashimoto’s or hypothyroidism, then thyroid hormone supplementation can help. However, not everyone with hypothyroidism or Hashimoto's needs thyroid hormone supplementation right away – or at all. Sometimes you can wait and see if your symptoms and labs improve over time without starting hormone supplementation.

Making the Decision about Thyroid Hormone Support

1. When thyroid labs are only mildly out of the normal range as defined here, and your symptoms are mild, in other words, not notably affecting your health or quality of life right now, you may prefer to take a wait and watch attitude, with a plan for rechecking labs and reassessing the situation every 3-6 months with your care provider, and addressing your possible Root Causes. This is almost always the approach I take in my medical practice.
2. If your thyroid labs are only mildly out of range, but you are very symptomatic to the point where your quality of life is affected or imbalances are showing up in your health parameters (i.e., you’ve gained a substantial amount of weight, you experience cognitive function changes like brain fog, or your cholesterol is elevated), then you might want to start thyroid hormone while looking for underlying and possibly reversible Root Causes of your hypothyroidism.
3. When your labs are significantly out of the normal range (i.e., they are at or exceed even the conventional ranges discussed here in this article or in The Adrenal Thyroid Revolution, and you have no symptoms, you might consider a wait and watch approach as discussed in point #1 above, but if you are symptomatic, I recommend starting thyroid hormone supplementation while addressing Root Causes.
4. If you’re pregnant and have high TSH or Low Free T4 or Free T3, there’s a good chance you need thyroid hormone supplementation. Speak with your doctor or midwife about this, and listen in here to learn more about thyroid in pregnancy.

Can I Put Off Taking Thyroid Medication?

With patients who have lab results and symptoms that all support a diagnosis of mild Hashimoto’s or hypothyroidism, I often spend at least 6, and often up to 12 weeks helping them to identify Root Causes of the thyroid problem before we start thyroid hormone supplementation. I’ve had patients with low iodine and non-autoimmune hypothyroidism for example, who reversed their thyroid problem with iodine supplementation, and I’ve seen removal of gluten in patients with celiac disease reverse Hashimoto’s in a matter of months. Once we identify the Root Cause(s), we may then work to reverse these for several additional months, before starting thyroid hormone supplementation, and reassess regularly, usually every 6-12 weeks, based on symptoms and repeat lab results.

However, if your lab results are far out of the normal range, if your symptoms are impacting your quality of life, or if you’ve been working on Root Causes for 6 weeks or more and your symptoms haven’t improved at all, nor have your labs (or they are getting worse), this is when I generally recommend starting thyroid hormone supplement. It can be a game changer in how you feel. As one woman shared, “Getting on the right thyroid treatment at the right dose changed my life. It felt like the windshield wipers came back on in my brain and I could think clearly again for the first time in years!”

Of course, I recommend continuing to address Root Causes all the while, because these not only potentially led to the thyroid problem, but can lead to other health problems as well.

What are the Risks if I Don’t Take It?

Outside of pregnancy, there’s no hard and fast rule in conventional medicine that says you must take thyroid medication before the TSH exceeds 10 and you’re symptomatic. However, good quality scientific studies have shown that even slightly elevated TSH and mildly slow thyroid functioning is associated with higher risks of decline in both cardiac and cognitive functioning. Further, slow thyroid functioning associated with elevations in the “bad” type of cholesterol (LDL), and reductions in the protective type (HDL). Depression can also have a terrible impact on your life, and if it’s due to hypothyroidism, the right treatment can quickly turn this around. Therefore, in my medical practice, while I am not fast to jump on treating hypothyroidism with pharmaceuticals, I also weigh the risks of not treating seriously.

Does It Really Make a Difference?

Most women I work with who need – and do start taking – thyroid hormone experience a dramatic improvement in their mood, energy, hormones, sleep, weight, focus, and overall sense of well-being. If they’d been deeply exhausted and unable to participate much in their life, they often feel they’ve gotten their lives back. Further, studies show that women with even borderline low thyroid function as shown on lab tests, maintain better cognitive and cardiac function when treated with low dose thyroid hormone supplementation, suggesting a protective effect. 

How Will I Know if It’s Helping?

It can take several months to achieve the right dose of thyroid hormone supplement, and sometimes even a bit of trial and error to find the right product for you, but once you’re on the correct dose of the right thyroid product, you should notice symptoms improving rather quickly – often within days. Also, within about 6 weeks of reaching that right dose, a recheck of your thyroid labs, particularly your TSH, Free T3, and or Free T4 should show that the values are starting to come into the normal range. This is how you know it’s helping.

However, keep in mind, that if you have Hashimoto’s, thyroid hormone supplementation will improve symptoms because it is giving your body the tools to carry out thyroid function; it does not stop the autoimmune attack against your thyroid or prevent further thyroid damage. To do this, it’s important to address root causes and use supplements, such as selenium, which help reduce the antibodies attacking the thyroid and causing damage.

Is Thyroid Hormone Safe?

If your body is not making or using the thyroid hormones you need for metabolism, brain, heart, and hormonal health then taking it is not only safe, but actually potentially very beneficial. However, caution is needed. Again, before taking thyroid hormone, confirm that you need it with proper laboratory testing.

Second, know the risks and benefits of the different types of thyroid hormone and the product(s) you're taking. T4 supplementation has very little risk, unless you are over-supplementing, in which case, you can put yourself into hyperthyroidism which may sound fun if you’re feeling sluggish and slow – but can be dangerous. It can cause insomnia, anxiety, increased bone turnover (over time leading to bone loss), and importantly, can cause dangerous changes in your heart rhythm, causing too rapid a heart rate, and irregular heart rhythms!

T3 supplementation, which again, is taking the active form of thyroid hormone, carries more risks of sending you into hyperthyroidism and more quickly, so requires significantly more care in using it.

Is it Going to Make Me Dependent?

Contrary to what many people think, thyroid hormone supplementation does not make your thyroid stop working on its own, and does not make you dependent on the medication. However, many women who do need to start thyroid hormone supplementation will ultimately need to stay on it – but this is because by the time they started taking the medication there was already substantial destruction of the thyroid by antibodies that may have been present for years even before the Hashimoto’s diagnosis was made. Dr. Izabella Wentz, The Thyroid Pharmacist who also teaches people how to address the Root Causes of Hashimoto’s and hypothyroidism, herself has Hashimoto’s, and in a candid interview with me here, explains why she still requires daily treatment with thyroid hormone.

Some women can eventually discontinue taking thyroid hormone supplementation and there’s no clear way to predict who this may be, though having high anti-TPO antibodies for many years suggests a higher likelihood that you’ll need to stay on hormone treatment. If you’d prefer to be off thyroid hormone supplementation, you can work with your primary provider to see if this is possible.

How Do You Know If I Still Need It?

Once you’ve been feeling great for several months, you can work with your primary provider to do a trial tapering down of your dose. This is done by slightly lowering the dose, and then testing your TSH, FT3, and FT4 about 6 weeks later; if they are out of range off the medication, you probably need to stay on it. If, however, you are staying steady in your labs, and without a return of symptoms, it may be possible to now take a lower dose, or continue the taper and rinse and repeat on the testing, to see if you can discontinue it.

In my medical philosophy, and personal life, I always try to take the non-pharmaceutical approach to health and healing whenever possible. However, I also recognize that we live in times when the impact on our health due to factors that may have even been beyond our control – for example, exposures to environmental toxins that can damage the thyroid – sometimes necessitate that we use the broad range of what's available to us, including thyroid hormone support. Thyroid hormone support doesn't mean we get to stop doing all of the other things it takes to feel great and be healthy like eating well, getting enough sleep, and making time for self-care, but it can give you the edge you need to get started on those if fatigue from hypothyroidism has been getting in your way. In fact, it can give you a new lease on life!